Child psychiatry: Key concepts and clinical insights

Professor Vance

Outline of Presentation:

1. What does a child psychiatry diagnosis mean?2. Why clinical interview and questionnaires are helpful3. Key comorbid conditions within a developmental context4. Nature versus nurture – some comments5. Key biological factors6. Key psychosocial factors7. Key principles of treatment

Professor Vance

1. What does a child psychiatry diagnosis mean?

a behavioural or psychological pattern of symptoms

associated with

impairment in family, social and/or academic domains

Professor Vance

1. What does a child psychiatry diagnosis mean?

in children and adolescents-

developmentally inappropriate impairment has to be judged relative to children of the same age, gender and IQ

this requires longitudinal assessment within and acrossdevelopmental stages

Professor Vance

1. What does a child psychiatry diagnosis mean?

multi-informant report - parent, teacher, child

low concordance repeatedly shown

externalizing: parent-teacher: increased agreementinternalizing: child-teacher: increased agreement

Professor Vance

-high prevalence psychiatric disorders-

‘externalizing’ oppositional defiant disorderconduct disorder

attention deficit hyperactivity disorder

‘internalizing’ anxiety disorders

depressive disorder

Professor Vance

2. Why clinical interview and questionnaires are helpful

Professor Vance

2. Why clinical interview and questionnaires are helpful

greater than 1.5 standard deviations from the meanbrain and environment behave differently

as if a clinical ‘threshold’ has been crossed

Professor Vance

3. Key comorbid conditions within a developmental context

oppositional defiant/conduct disordersanxiety disordersdepressive disorderslearning disorders (language-based/visuo-spatial)developmental coordination disorder

Professor Vance

Professor Vance

4. Nature versus nurture – some comments

nature primary driver

primary driver nurture

nature nurture

common antecedent

Professor Vance

Professor Vance

Professor Vance

5. Key biological factors

Executive functioning

Response inhibition: motor and cognitionoptimise response speed and accuracy

Working memory: verbal and visuospatialoptimise span and strategy

5. Key biological factors

Mood dysregulation: decrease irritabilityincrease emotional salience

Arousal dysregulation: optimise physiological arousaloptimise habituation

Professor Vance

6. Key psychosocial factors

[A]parental psychopathology: alcohol/depressive/anxiety ds

[B] marital functioning:

family functioning:

peer group functioning:

“flexibility/adaptiveness/regulation of affect/problem solving”

sociocultural context affects the character of these aspectsand their detection

Professor Vance

Professor Vance

7. Key principles of treatment

1. maximize the psychological and social context in which the child is immersed to maximize the child’s learning environment

“consistent, attuned, sensitive and responsive…”

2. medications can be helpful to facilitate the child’s ability tolearn in home and school environments

3. each child needs complete re-review every six months

Professor Vance

Professor Vance